Effects of malnutrition and overweight on outcomes in STEMI patients
史昊文 1王艺雯 2陆远 2李雷1
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作者信息
1. 221006 徐州,徐州医科大学附属医院全科医学科
2. 221006 徐州,徐州医科大学附属医院心内科
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摘要
目的 探讨营养不良对ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者发生主要心血管不良事件(Major Adverse Cardiovascular Events,MACE)的影响.方法 选取2019年12月至2020年12月于徐州医科大学附属医院CCU收治的STEMI患者534例,收集基线资料,根据入院时体质指数(Body Mass Index,BMI)以及通过控制营养状态评分(Controlling Nutritional Status Score,CONUT)分为营养不良非超重组(n=155)、营养不良超重组(n=224)、营养良好非超重组(n=49)和营养良好超重组(n=106),比较四组患者基线资料及出院后MACE发生情况,绘制K-M曲线及Log-rank检验四组间差异,多因素Cox回归筛选STEMI患者预后不良因素.结果 在随访期内(中位数为18个月),共发生MACE 62例,其中16例心血管死亡,11例再发心肌梗死,26例非计划血运重建和19例非致命性脑卒中.Log-rank检验及四组间两两比较可得营养不良非超重组预后最差(P<0.05).多因素Cox回归分析显示营养不良非超重(HR=2.048,95％CI:1.235～3.396,P=0.005)、Killip Ⅱ～Ⅳ级(HR=2.323,95％CI:1.126～4.793,P=0.023)、吸烟(HR=2.681,95％CI:1.484～4.844,P=0.001)、年龄>55岁(HR=3.447,95％CI:1.454～8.173,P=0.005)是STEMI患者不良预后的独立危险因素.结论 营养不良非超重是STEMI患者不良预后的独立危险因素.
Abstract
Objective To investigate the effects of malnutrition and overweight on ST-elevation myocardial infarction (STEMI) patients with Major Adverse Cardiovascular Events (MACE).Methods A total of 534 STEMI patients admitted to the CCU of the affiliated hospital of Xuzhou Medical University from December 2019 to December 2020 were selected.Assessed by Body Mass Index (BMI) at admission and Controlling Nutritional Status Score (CONUT) were divided into malnutrition non-overweight (n=155);malnutrition overweight (n=224);nutrition non-overweight (n=49) and nutrition overweight (n=106).The baseline data of the four groups and the occurrence of MACE after discharge were compared.Kaplan-Meier curve was drawn and Log-rank was used to test the differences among the four groups.Multivariate Cox regression was used to screen for adverse prognostic factors in STEMI patients.Results During the follow-up period (median 18 months),62 cases of MACE occurred (16 cardiovascular deaths,11 recurrent myocardial infarction,26 unplanned vessel revasculation,and 19 nonfatal strokes).Comparison among the four groups showed that the prognosis of malnutrition non-overweight was the worst (P＜0.05).Multivariate Cox regression analysis showed that malnutrition non-overweight (HR=2.048,95％CI:1.235～3.396,P=0.005),KILLIP Ⅱ～Ⅳ(HR=2.323,95％CI:1.126～4.793,P=0.023),smoking history(HR=2.681,95％CI:1.484～4.844,P=0.001),and age＞55 years old (HR=3.447,95％CI:1.454～8.173,P=0.005) were independent risk factors for poor prognosis in STEMI patients.Conclusion Malnutrition non-overweight is an independent risk factor for poor prognosis in STEMI patients.
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